tag:blogger.com,1999:blog-2760353953251845523.post4161820181929693190..comments2015-03-31T17:49:32.538-04:00Comments on Buckeye Surgeon: Lap Chole TipsJeffrey Parks MD FACShttp://www.blogger.com/profile/15650563299849196122noreply@blogger.comBlogger10125tag:blogger.com,1999:blog-2760353953251845523.post-87630718691487007372011-08-25T11:13:27.028-04:002011-08-25T11:13:27.028-04:00we never do cholangiogram if USG and LFT are norma...we never do cholangiogram if USG and LFT are normal. And as per our research outcomes didnt differ in terms of post-op complications if we keep conversion cases apart. So wrong idea to do cholangiogram in every case. Also it may precipitate pancreatitis, am not sure.Rameshhttp://www.blogger.com/profile/15917172941373955812noreply@blogger.comtag:blogger.com,1999:blog-2760353953251845523.post-37033583566136978822011-08-25T11:08:16.460-04:002011-08-25T11:08:16.460-04:00we as a surgeon never do cholangiogram if USG show...we as a surgeon never do cholangiogram if USG shows normal CBD and LFT. And to our research no problems in lap chole, if conversion cases are kept apart. So wrong ideaRameshhttp://www.blogger.com/profile/15917172941373955812noreply@blogger.comtag:blogger.com,1999:blog-2760353953251845523.post-49574393074870345362010-08-19T23:04:58.552-04:002010-08-19T23:04:58.552-04:00I&#39;m a surgical tech in Cincinnati and have fou...I&#39;m a surgical tech in Cincinnati and have found your tips to be helpful for me while I&#39;m doing some pre-op research. While I know every surgeon will have his or her own methods, I like how straightforward you&#39;ve been in this post, and it&#39;s given me another perspective on biliary surgery.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-2760353953251845523.post-75710797866779435942009-04-11T02:41:00.000-04:002009-04-11T02:41:00.000-04:00I do cholangiograms selectively (probably 10-15%) ...I do cholangiograms selectively (probably 10-15%) and will continue to do it that way. To me, an unnecessary operative step is inelegant - I get no warm fuzzies from doing a gram. And they do not reduce complication rate.<BR/><BR/>There is only one maneuver which reduces biliary complication and that is conversion to open prior to cutting any ductal structure. I think we as a group probably do not do this often enough, and I include myself in that assessment.<BR/><BR/>I don't use Veress for lap chole, but I do use it for lap appy - that's because I take the GB out through the umbilical site (Hasson) but I take the appy out through the LLQ port site and prefer to minimize the size of the umbo site for appy. I thank Joe S. for the reference from Surg Endos. I remember a prior article in British J Surg (2001-3 roughly) comparing complication rates from Veress and Hasson and finding them essentially equal at 0.1%. This was a very well done review with very large numbers of patients and I recall completely buying into the data. That's another reason why I do not advocate one way or the other of getting access. Just do it carefully.<BR/><BR/>For anonymous having a lap chole - please don't try to suggest to your surgeon how to do the procedure from a technical standpoint (unless you are board certified in surgery).victorlazhttp://victorlazaron.wordpress.com/noreply@blogger.comtag:blogger.com,1999:blog-2760353953251845523.post-55693829883487410022009-04-07T21:18:00.000-04:002009-04-07T21:18:00.000-04:00I'm having a lap chole on Friday. How do I push m...I'm having a lap chole on Friday. How do I push my surgeon to do the dye test and use a bag without making him angry that I'm telling him how to do his job?Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-2760353953251845523.post-53159540765001215782009-04-03T20:41:00.000-04:002009-04-03T20:41:00.000-04:00The cholangiogram is the second pair of eyes for t...The cholangiogram is the second pair of eyes for the single surgeon. It may open a different perspective and like the author states, if omitted there is a sense of incompleteness. I like the cholecystocholangiogram and the cystic duct marking technique. 2 or 3 clips are placed next to the proposed cystic duct before shooting the cholangiogram. It helps eliminate ambiguity and helps create an anatomic proof of identity. JACS 203:257,2006.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-2760353953251845523.post-79811112163802720362009-04-03T16:10:00.000-04:002009-04-03T16:10:00.000-04:00I really like General Surgery News and I like your...I really like General Surgery News and I like your review on this article.<BR/><BR/>I also agree with most of what you're saying. How can we possibly justify having 2 board-certified surgeons for every LC? Geeze... might as well spit on the whole risk/benefit and cost control push.<BR/><BR/>I too share the same feeling about the Veress needle approach. However, I know 2 excellent surgeons that use it routinely and safely. That being said, this is a timely topic as there was an article published in the last issue of Surgical Endoscopy. Despite my bias for the open Hasson approach, I will leave you with the abstract.<BR/><BR/>Title:<BR/>Primary access-related complications in laparoscopic cholecystectomy via the closed technique: experience of a single surgical team over more than 15 years. <BR/><BR/>Authors:<BR/>Prakash Kumar Sasmal, Om Tantia, Mayank Jain, Shashi Khanna, Bimalendu Sen<BR/><BR/>Abstract<BR/>Background Laparoscopic cholecystectomy (LC), a common laparoscopic procedure, is a relatively safe invasive procedure, but complications can occur at every step, starting from creation of the pneumoperitoneum. Several studies have investigated procedure-related complications,<BR/>but the primary access- or trocar-related complications generally are underreported, and their true incidence may be higher than studies show. Major vascular or visceral injury resulting from blind access to the abdominal cavity, although rare, has been reported. Of the two methods for creating pneumoperitoneum, the open access technique is reported to have the lower incidence of these injuries. The authors report their experience with the closed method and show that if performed with proper technique, it can be as<BR/>rapid and safe as other techniques. However, injuries still happen, and the search for the predisposing factors must be<BR/>continued. <BR/><BR/>Methods Between January 1992 and December 2007, a retrospective study examined 15,260 cases of LC performed for symptomatic gallstone disease in the authors’<BR/>institution by a single team of surgeons. The primary access-related injuries in these cases were retrospectively analyzed.<BR/><BR/>Results In 15,260 cases of LC, 63 cases of primary access-related complications were identified, for an overall incidence of 0.41%. Major injuries in 11 cases included<BR/>major vascular and visceral injuries, and minor injuries in<BR/>52 cases included omental and subcutaneous emphysema. <BR/><BR/>For the closed method, the findings showed an overall incidence of 0.14% for primary access-related vascular injuries and 0.07% for visceral injuries.<BR/><BR/>Conclusion Primary access-related complications during LC are common and can prove to be fatal if not identified early. The incidence of these injuries with closed methods is no greater than with open methods. <BR/><BR/>No evidence suggests abandonment of the closed-entry method in laparoscopy.Joseph Sucher, MD FACShttp://www.blogger.com/profile/09187702675709935451noreply@blogger.comtag:blogger.com,1999:blog-2760353953251845523.post-43334208738711244882009-04-03T13:08:00.000-04:002009-04-03T13:08:00.000-04:00Agree with all of the above. We have a small grou...Agree with all of the above. We have a small group of general surgeons, down to 4, one left. We don't have the luxury of having two general surgeons for every case, except maybe the really complicated ones (rare). Also, opening is not a sign of failure, can't believe anyone ever got sued on opening after a laparoscopic cholecystectomy. Love using a ranfac catheter for IOCs. KAnonymousnoreply@blogger.comtag:blogger.com,1999:blog-2760353953251845523.post-65034348899099201682009-04-03T12:57:00.000-04:002009-04-03T12:57:00.000-04:00oh and too bad about missing out on Jay Cutleroh and too bad about missing out on Jay CutlerAnonymousnoreply@blogger.comtag:blogger.com,1999:blog-2760353953251845523.post-65581054844506163022009-04-03T12:56:00.000-04:002009-04-03T12:56:00.000-04:00you never fail to deliver a perfect ratio of techn...you never fail to deliver a perfect ratio of technical, emotional and controversial posts. Keep em coming buckeyeAnonymousnoreply@blogger.com